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cardio and pulm > LA cardiac pt 2 > Flashcards

LA cardiac pt 2 Flashcards

1
Q

cardiogenic shock CO, SVR, systolic/diastolic

pcwp

A

decreased CO and increases SVR

systolic

PCWP increased

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2
Q

etio of cardiogenic shock

A

cardiac d/s: MI, myocarditis, valve dysfunction, congenital hrt disease, CM, arrhythmias

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3
Q

avoid what in cardiogenic shock

tx

A

aggressive IV fluid tx.

inotropic support: dobutamine, epi

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4
Q

s/s of cardiogenic shock

A

severe respiratory distress

cool, clammy skin

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5
Q

best LDL lowering drugs

A

statins! bile acid sequestrants

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6
Q

best meds to lower TG

A

fibrates! niacin

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7
Q

best meds to increase HDL

A

Niacin! fibrates

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8
Q

lipid meds for type 2 DM

A

statins, fibrates

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9
Q

common valve for endocarditis

A

mitral>atrial>tricuspid>pulm

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10
Q

organism for endocarditis: nml valves/tx

A

st. aureus

nafcillin or oxacillin plus either ceftriaxone or gentamycin

vanco if needed

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11
Q

organism for endocarditis: abnormal/damaged valves/tx

dental procedures

A

st viridans

?

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12
Q

organism for endocarditis: IV drug users /tx

A

st aureus or MRSA

vanco

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13
Q

organism for endocarditis: prosthetic valves/tx

A

staph epidermis

vanco+genta+rifamin

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14
Q

fungal for endocarditis: tx

A

amphoteracin B 6-8 weeks

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15
Q

great gm + coverage

A

PCN and vanco

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16
Q

great gm- coverage

A

gentamycin and ceftriaxone

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17
Q

immunologic phenomena (4)
for endocarditis

A

osler’s nodes, roth spots, +RF, acute glomeronephritis

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18
Q

vascular and embolic phenomena in endocarditis (4)

A

janeway lesions, septic arterial or pulm emboli, ICH

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19
Q

endocarditis test to order first

more sensitive

A

TTE

TEE

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20
Q

endocarditis prophylaxis and what procedures

A

2 gm amox 30-60 min before procedure or clinda 600 if allergic

dental, respiratory, infected skin

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21
Q

pericarditis 2 most common causes

A

idiopathic and viral(coxsackievirus and echovirus)

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22
Q

pericardial friction rub heard best how

A

end expiration, upright, leaning forward

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23
Q

tx for dressler syndrome

A

aspirin or colchicine

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24
Q

avR shows knuckle sigh

A

pericarditis

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25
electrical alternans
pericardial effusion
26
most common non traumatic cause of tamponade
malignancy
27
pulsus paradoxus
>10 mmHg decrease of systolic BP with inspiration
28
S/s of tamponade
cool extremities, reflex tachycardia, peripheral edema, dyspnea, fatigure, shock
29
cool extremities, reflex tachycardia, peripheral edema, dyspnea, fatigure, shock
S/s of tamponade
30
tamponade echo
pericardial effusion + diastolic collapse of cardiac chambers
31
square root sign on echo
constrictive pericarditis early diastolic dip followed by a plateau of diastasis.
32
constrictive pericarditis leads to restriction of what affects which side of heart
ventricular diastolic filling right
33
constrictive pericarditis HF signs
right: JVD, kussmaul, increased hepatojugular reflex, N/V, peripheral edema
34
constrictive pericarditis tests sensitivity
CXR echo (rule of restrictive CM), square root sign CT/MRI: more sensitive: pericardial thickening
35
pulsus paradoxes
drop > 10mmHg of systolic BP with inspiration: pericardial tamponade and constrictive pericarditis
36
electrical alternans seen in what
pericardial effusion
37
EKG in acute pericarditis
diffuse ST elevations(concave) in precordial leads with PR depressions in same leads, T wave inversions, resolution avR: ST depression and PR elevation
38
AAA, what size is nml and aneurysmal
1.5cm and 3.0 cm
39
AAA most common site
infrarenal
40
RF for AAA
smoking(main modifiable), age>60, caucasian, male, hyperlipidemia, atherosclerosis, connective tissue d/o, syphillis, HTN
41
AAA protective factors
female, DM, non caucasian, moderate alcohol consumption
42
describe aortoenteric fistula with AAA
presents as acute GI bleed in pts who underwent prior aortic grafting
43
best test for AAA
best initial test: CT with contrast, only do in symptomatic hemodynamically stable pts abd u/s for asymptomatic pts to monitor progression
44
symptomatic hemodynamically unstable pts AAA
focused bedside U/S
45
AAA screening ages 3-4 cm 4-4.5 cm >4.5 cm >5.5 or >0.5 cm
* one time screening via u/s in men 65-75 3-4 cm: u/s every year 4-4.5 cm: u/s every 6 months >4.5 cm: vascular surgeon referral >5.5 or >0.5 cm: immediate surgical repair, even if asymptomatic
46
aortic dissection definition and most common 2 sites high mortality where
tear through the innermost layer of the aorta intima due to cystic medial necrosis ascending most common near the aortic arch of left subclavian (65%); descending 20% ascending is high mortality
47
3 types of aortic dissection (Debakey)
type 1: originates in ascending aorta propagates to at least the aortic arch and often beyond it distally type 2: originates in and confined to ascending aorta type 3: originates in descending aorta and rarely extends proximally but it will extend distally
48
BP and pulse with aortic dissection
unequal BPs in each arm, decreased peripheral pulses
49
if aortic dissection is ascending, what new murmur is heard
AR
50
aortic dissection imaging
CT angiogram most common first line. CXR will show wide medialstinum: classic.
51
aortic dissection Stanford 2 types
A. involves ascending aorta and/or aortic arch, and possible descending aorta (anterior CP) B: involves descending aorta(distal to the left subclavian artery origin), without involvement of ascending aorta and/or aortic arch
52
describe PAD and ischemic rest pain
in advanced disease, most common at night and relieved with foot dependency
53
PAD skin on exam
atrophic: atrophy, thin/shiny, hair loss, thickened nails, COOL limbs, areas of necrosis. *lateral malleolar ulcers NO EDEMA
54
skin: atrophic: atrophy, thin/shiny, hair loss, thickened nails, COOL limbs, areas of necrosis. *lateral malleolar ulcers NO EDEMA
PAD
55
color of limb pale on elevation, dependent rubor
PAD dusky red with dependency
56
dusky red with dependency: limb color
PAD
57
PAD dx test gold standard
ankle brachial index most useful screening test. nml is 1-1.2 positive if ABI< 0.90; 0.50 if severe. rest is <0.4 gold standard is arteriography
58
ABI >1.2
calcified vessel, may lead to false reading
59
describe acute arterial occlusion location
vascular emergency, most common is thrombotic occlusion (with preexisting PAD). most common in superficial femoral artery. (or popliteal)
60
PAD vs PVD 1. oxygen 2. shape of wounds 3. temp of leg 4. edema 5. skin color 6. pain
PAD: oxygen problem, round red sores, pale/cold, NO EDEMA, sharp pain PVD: not oxygen problem, irregular shaped sores, warm leg, EDEMA pooling, yellow/brown, dull pain
61
6 Ps for arterial occlusion
pain, pallor, paresthesias(often early), pulselessness, poikothermia, paralysis(late finding associated with worse prognosis).
62
arterial occlusion workup
bedside arterial doppler, CT angiography quicker.
63
arterial occlusion tx
reperfusion; thromboembolectomy unfractionated heparin and fluid resuscitation for supportive tx
64
distal extremity ischemia both upper and lower extremities, raynaud's phenomenon, superficial migratory thrombophlebitis
buerger's disease, thromboangiitis obliterans small and medium vessel vasculitis
65
buerger's disease, thromboangiitis obliterans dx testing
abnormal allen test aortography: corkscrew collaterals bx: segmental vascular inflammation
66
corkscrew collaterals
buerger's disease, thromboangiitis obliteran
67
most common primary cardiac tumor, location
atrial myxoma, 80% occur in left atrium
68
"ball valve" obstruction of mitral orifice mimicking mitral stenosis on transesophageal echo
atrial myxoma
69
triad of embolic phenomenon, MS like sx, flu like sx
atrial myxoma
70
prominent S1, low pitched diastolic murmur
atrial myxoma or MS
71
only shock with increased PWCP
cardiogenic
72
only shock with increased CO
septic
73
2 shocks with increased SVR
cardiogenic and hypovolemic
74
only shock with decreased HR
neurogenic
75
electrical alternans, cardiac tamponade
76
3 sign, coarctation

cardio and pulm (24 decks)

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